After a strenuously ongoing battle against COVID-19, the World Health Organization has recently announced that there is now a new global outbreak upon us. With cases in over 50 countries and spreading across five regions, the monkeypox outbreak is surfacing its way around the world. This outbreak has affected more than 20,000 people and is entering many countries that have historically never seen the virus.
Although the symptoms are not typically severe or fatal, the zoonotic virus is rapidly unfurling throughout the globe and spreading at a rapid rate. The quick spread and the uncertainty of the virus led the World Health Organization to declare monkeypox a global health emergency.
What is monkeypox?
Comparable to smallpox, monkeypox is a slightly less severe zoonotic virus (animal-to-human transmission) that originated in lab-kept monkeys in 1958. With the help of vaccinations, doctors have managed to keep smallpox under control, making the monkeypox virus the dominant orthopoxvirus to monitor.
From what is known, there are two different genetic clades of monkeypox: the Congo Basin clade and the West African clade. The West African clade is known to have a less severe disease case, with a 3.6% fatality rate, compared to the Congo Basin clade of 10.6%. As of now, all cases that have been reported by PCR (Polymerase Chain Reaction tests) are from the West African clade.
The first human known case was reported in 1970 when they found the virus in a child from the Democratic Republic of the Congo. This area, along with other rural rainforest regions in the Congo, is the main location where cases were later reported.
Since the first case in 1970, monkeypox has spread to many different parts of the world, including Israel, the United Kingdom, and the United States. The first outbreak outside of Africa was discovered in the United States in 2003 when the virus was found in and linked to infected pet prairie dogs.
Being kept with dormice and Gambian pouched rats that were imported from Ghana, these contaminated prairie dogs led to over 70 cases of monkeypox in the United States. While the virus has since been spreading rapidly, it is still unknown what the real essence of monkeypox is.
How is it contracted?
Human-to-human exposure
Monkeypox can be spread to anyone who is in close contact with an infected person. Respiratory droplets, close contact with lesions, and touching contaminated materials are all different ways that monkeypox is contracted human-to-human. Getting the virus from close contact, such as face-to-face, usually requires that it is a prolonged amount of time spent with an infected person, putting healthcare workers and caretakers at greater risk.
In addition, transmission can also occur between mother and fetus through the placenta during pregnancy, leading to congenital monkeypox and putting pregnant women at higher risk.
Others who are at greater risk of monkeypox are those who are male in the bisexual and gay community. Monkeypox is not a sexually transmitted disease but is transmitted through close and personal contact. There is no evidence that it spreads through seminal or vaginal fluids, but it is known that people contracting the virus often have their first lesions form in the anorectal or genital areas.
With the recent monkeypox outbreak in humans, it is unclear how often it is spread through respiratory secretions, if it spreads when someone has no symptoms, or whether it can spread through sexual activity. Further research is needed to be done to answer these key concerns and understand the outbreak fully. Some might suggest that changes circling human behavior might be a critical factor for the outbreak.
“The current global outbreak of monkeypox virus infection in humans suggests changes in biologic aspects of the virus, changes in human behavior, or both; such changes might be driven by waning smallpox immunity, relaxation of coronavirus disease 2019 (Covid-19) prevention measures, resumption of international travel, and sexual interactions associated with large gatherings.” - nejm.org
Animal-to-human exposure
Monkeypox has spread throughout other animal communities, even though it was a virus that was first discovered in monkeys. Gambian pouch rats, dormice, rope squirrels, and tree squirrels, are also known to be infection carriers.
Coming in contact with an animal that is infected with monkeypox usually involves direct contact with blood, lesions, or bodily fluids. Additionally, consuming undercooked meat and other contaminated animal products can put someone at higher risk for contraction.
What are the symptoms?
While the symptoms are generally mild and self-limited, the illness normally lasts for 2-4 weeks. The symptoms typically start within 3 weeks of viral exposure, with varying symptoms. Some people have experienced flu-like symptoms before getting a rash, while others have gotten the rash before other symptoms. Others have only experienced a rash.
Monkeypox rash
The rash associated with monkeypox may be located near the genital areas, the anus, and sometimes the chest, face, mouth, feet, and hands. Initially, the rash may appear as blisters or pimples and may be accommodated by itchiness and pain. Before the rash heals, it will go through several different stages, including scabbing.
Other Monkeypox symptoms
Additional monkeypox symptoms can include respiratory symptoms varying from a cough, nasal congestion, or sore throat. Running a fever, having chills, swollen lymph nodes, and exhaustion are also common symptoms to look out for. Lastly, different types of aches such as headaches, backaches, and muscle aches can be symptoms of monkeypox.
How can we prevent monkeypox?
With the World Health Organization declaring monkeypox a global emergency, it raises awareness and can help get tools and vaccinations to poorer countries. Vaccinations are being given to those who are at risk for close contact, such as health workers.
Luckily for this outbreak, there is already a vaccine to help fight the virus that was originally developed for smallpox. While monkeypox does not spread as easily as the coronavirus, it is spreading fast and entering many counties that have historically never seen the virus.
Unanswered questions still remain regarding the natural history of the monkeypox virus. Further studies are needed to determine the exact source and how the virus circulates in nature.
In non-endemic countries with cases, there are ongoing investigations regarding public health. Laboratory investigations, clinical management, and contact tracing are among the ongoing studies being conducted. Where accessible, genomic sequencing is being administered to discover what clades are visible during this outbreak. So far from this outbreak series, all cases that have been reported by PCR are from the West African clade.
Making sure to steer clear of close contact with infected people and avoiding fabrics or objects that might have been used by someone with monkeypox can help prevent contracting and spreading the virus. Additionally, avoid undercooked meats and consuming other various products of infected animals.
Lastly, keeping hands clean with hand sanitizer and frequent washing, especially before touching your face or eating and after using the restroom, can help protect you from infection.
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Shiana Irlbeck is a content writer for the International Youths Organization for Peace and Sustainability. She also holds a BS in Psychology from Iowa State University.
Inputs and Edits by Sovena Ngeth.